Before reading this article you may wish to pause and reflect for a moment as to how you feel when a new client walks through your door experiencing some kind of acute or chronic pain- for example; a herniated disc, persistent low back pain, frozen shoulder, carpal tunnel syndrome, whiplash, or a sports injury. Do you feel excited at this opportunity to help someone reduce their pain, gain a repeat client and enhance your word of mouth reputation? Or are you unconfident, unsure of how massage can help, hesitant in your treatment, or feel that you should be referring the client on to an osteopath or physiotherapist instead? If the answer is the latter then you may wish to read on – and don’t worry, you are not alone! Lack of training in the treatment of pain is one of the most common gaps in knowledge identified by British massage therapists today. Most qualifying courses enable us to do a great relaxation massage but leave students lacking when it comes to those clinical problems so common in the general public- bad backs, sore necks, shoulder or wrist problems. Even therapists gaining sports massage qualifications are often unsure about how to go about getting results with some of the techniques they have learned.

The great news for the massage profession is that skilfully applied massage using appropriate techniques and knowledge is highly effective in treating pain conditions. Using a proficient combination of the right techniques, many clients can experience a reduction in their pain levels within 6 weekly sessions and often as few as 1-3 treatments. This can do wonders for your enthusiasm for your work and of course your marketing – nothing enhances your word of mouth publicity more than a treatment resulting in relief from pain.

Principles of the Fix in Six approach to treating acute and chronic pain

Can you really make a lasting result in a maximum of 6 weekly sessions? Our experience suggests you can; most common musculo-skeletal injury and pain responds well to this approach; frequently achieving a pain free period by weeks 3 or 4. Once you have reached a pain free period, you can lengthen the time between treatments so you might next book your client in for 2 weeks time. Eventually most clients can be moved onto monthly maintenance sessions to keep them out of trouble on an ongoing basis.

We have found that the most successful approach involves using a combination of both assessment and treatment skills as outlined below – you will need more than one tool in your massage toolkit to achieve effective results with different conditions. The best practitioners get results because they use a dynamic combination of skills, adapting each session with every client to create a unique and specialised treatment.

The Seven Golden Steps in the “Fix in Six” Approach

Step one: Take an effective case history and assessment

Developing good assessment and evaluation tools enables your practice to move onto a truly professional level. Quite simply, a good assessment enables us to plan effective treatments that achieve the goals or outcomes that the client desires. From a business point of view, achieving good outcomes leads to satisfied customers, which leads to a thriving and interesting practice. A good assessment enables you to see whether your treatment is working and gives you measurable benchmarks so both you and your client are able to assess progress.

Whether you are doing relaxation massage, sports massage, energy work or pregnancy massage, some form of assessment is vital. You always need to know why your client has come to you, what they are expecting from the treatment and a baseline for any changes you make.

Assessment is usually divided into 4 components, which you can remember, by the acronym “HOPS”:

• H -Health history questions (usually known as your case history or medical intake)

• O - Observations (i.e.: of posture)

• P - Palpation (of soft tissues including muscles and fascia)

• S - Special Orthopaedic Tests (specific tests that help us to identify problems more precisely)

Assessing the data from all of the above helps us to determine what may be the cause of soft tissue pain – for example does the problem lie with the muscles, tendons, ligaments, or joint capsule? This can help us determine the most appropriate treatment plan and the correct combination of technique. A frozen shoulder may present with similar symptoms to trigger points in the rotator cuff muscles but will require a very different type of treatment. Assessment and orthopaedic testing helps us determine the type of soft tissue involved so our work can be more precise – as the great bodyworker Jean- Pierre Barrall, father of visceral manipulation says in his charming French accent ‘ if you are precise, ze results are lastable!”

Step two: Correct Application of Heat or cold

The results of your treatment can be greatly enhanced with the application of appropriate hydrotherapy. In general, chronic conditions respond best to heat whereas acute conditions should always be treated with cold (ice packs or direct moving ice application). Apply hot or cold to the painful area before your hands on techniques and you will find you get better results. You can also teach your client to apply hot or cold for themselves as a useful self help technique between treatments.

Step Three: Fascial Work

Myofascial work (MFR) is a powerful technique to add into the mix of your treatment plan for addressing musculo- skeletal problems. MFR techniques address the body’s fascial system, that is, the 3D fibrous connective tissue that holds the body together and gives it shape. Most commonly taught massage techniques fail to address the fascia, thus denying practitioners a large piece of the puzzle when treating pain conditions. MFR techniques aim to restore mobility in the fascia and soften connective tissue that has become rigid, with highly effective results. To be effective, fascial techniques should be performed without any oil therefore it is often most effective to do these at the beginning of your treatment.

Step Four: Release all the muscles around the affected joint using trigger point therapy

Thanks to the work of Dr Janet Travell, the doctor who pioneered trigger point work in the US, we have a growing body of evidence that many pain conditions are actually caused by trigger points or small contraction knots in the msucles. Studies suggest that trigger points are a component of up to 93% of the pain seen in pain clinics and the sole cause of such pain as much as 85% of the time. (Gershwin; Fishbain quoted in Travell and Simons: Myofascial Pain and Dysfunction: The trigger point manual Volume 1)

Trigger points are known to cause or contribute to low back pain, carpal tunnel symptoms, tennnis elbow, neck pain, migraines, jaw pain, and many kinds of joint pain mistakenly attributed to arthritis. They can cause sinus pain and congestion, nausea, chronic dry cough and are thought to contribute to fibromyalgia.

To gain truly efective results in the treatment of pain with trigger point techique, we recommend treating alll the muscles around the joint. This is a really important principle of treatment as most pain conditions will involve more than one muscle. So for example, if you have a client with a shoulder problem you will need to check the following muscles for trigger points: trapezius, rhomboids, supraspinatus, infraspinatus, teres minor, teres major, serratus anterior, subscapularis, latissimus dorsi, deltoid, pec major, pec minor, biceps, triceps and coracobrachialis.

Step Five: Use acupressure and meridian based techniques

Knowledge of relevant meridians and acupressure points can greatly enhance your treatment results. According to Traditional Chinese Medicine, meridians are the energy highways of the body and acupressure points are where this energy can be accessed and influenced. Recent research suggests strong connections between the meridians and the myofascia, with acupressure points being places where the fascia can be accessed at deeper levels. In my own clinic I have found a knowledge of acupressure points and meridians to be an excellent additional tool in the treatment of pain. So if you know relevant acupressure points, use them!

Step Six: Stretching Techniques

Once trigger points and myofascial restrictions have been removed, stretching will enable shortened muscles to return to their natural length, realign scar tissue to create a functional scar and promote energy flow in meridians to optimise healing. Stretching will enable your sporting clients to improve performance, prevent injury and treat it effectively when it occurs. You can use stretching with everyone from the athlete to the elderly and enable your clients to take greater control over their own health by teaching them to stretch between sessions. PNF stretching, Muscle Energy Technique and Active Isolated Stretching are all incredibly useful to get results in the effective treatment of pain.

Step Seven: Teach your client a self – help technique to use between sessions

Placing control over healing back in your client’s hands is an incredibly powerful psychological tool. There are many safe self help techniques that are within your remit as a massage therapist – for example instructing clients how to treat their own trigger points, showing self stretching, or teaching simple breathing and relaxation exercises to help deal with stress. Make sure you are only teaching your client techniques for which you are insured and knowledgeable (ie: don’t give nutritional advice if you are not a nutritionist)

Putting in all together

The above steps are like a tried and tested recipe – include all of these ingredients in your treatments and you will see an increase in your ability to get results. You will also need to use your own skill and creativity to determine which of the ingredients may be needed to a greater or lesser extent as the exact “recipe” will vary from client to client. So each treatment will be different, challenging and exciting for both you and the client!

Come see us at camexpo 2013

If you want to get great hands on training in all of the techniques described above then come see us at camexpo 2013 where we will be running several workshops in the treatment of pain including the ever popular Jing “Fix in Six” method. Be sure to book early as this is always one of the first workshops to sell out!

See you at the show!

About Rachel Fairweather and the Jing Institute of Advanced Massage

Rachel Fairweather is co-founder and director of the Jing Institute of Advanced Massage. Based In Brighton, London and Edinburgh we run a variety of courses in advanced techniques to help you build the career you desire. Our short CPD courses include excellent hands on learning in all the techniques described above including trigger point therapy, myofascial release, stretching and orthopedic assessment. For the therapist who wants to be the best they can possibly be, we offer a BTEC level 6 (degree level) in advanced clinical and sports massage – the highest level of massage training in the UK.

The work we teach is serious but we do it with a lot of laughter. We use innovative teaching methods that ensure that you leave courses with the material in your hands, head and hearts. All work is taught practically so that you can use it right away in your clinic.

Want to find out more? Please contact The JING Institute!

To find out more, visit Jing’s website www.jingmassage.com, as well as its Twitter and Facebook pages.

Penelope Quest is an internationally renowned Reiki Master, spiritual teacher and author, who began her journey of personal and spiritual discovery in the 1970s, developing skills as a clairvoyant and channel, but since 1991 her main focus has been mind/body healing techniques, personal growth and spiritual development. Penny worked as a Reiki Practitioner in her spare time for three years before becoming a Reiki Master (Teacher) of both the Usui and Usui/Tibetan Reiki traditions in 1994, and a Karuna Reiki® Master in 1996. Since then she has taught Reiki to thousands of students, and in 2000 she gained further experience and qualifications in the original techniques of Dr Usui from the traditions and lineage of Hiroshi Doi, a Reiki Master in Japan, and in 2003 she began working with another of Hiroshi Doi’s students to gain more knowledge and experience in the traditional Japanese techniques, to become a Gendai Reiki-ho Shihan, the name given to a Japanese Reiki Master who is able to teach all levels of Reiki in the traditional Japanese way – Shoden, Okuden and Shinpiden.

She is a qualified teacher (Cert.Ed) with fifteen years’ experience as a lecturer and senior manager in further and higher education, where she taught mainly management, marketing, communication and personal development. Her academic qualifications include an Open University BA in Psychology and Education and a Masters Degree (MSc) in Health and Healing Science from Lancaster University.

As a former Vice-Chairman and Education Co-ordinator for the UK Reiki Federation, she was involved with the Reiki Regulatory Working Group (RRWG—now called the Reiki Council) working with other Reiki organisations on producing an appropriate Core Curriculum for training professional Reiki Practitioners in the UK (full details of this are in her book “The Reiki Manual”). She has also been a consultant on Reiki for both the Open University and the NHS, and she is now a member of the Guild of Health Writers as the successful author of a number of best-selling and award-winning books on Reiki, all published by Piatkus in the UK, and by Tarcher/Penguin in the USA. These include: “Self Healing With Reiki“; “Living the Reiki Way“; “The Basics of Reiki“, as well as “The Reiki Manual“, which was written in collaboration with her daughter Kathy Roberts. Her latest book is an updated and much expanded 2012 edition of “Reiki for Life“, published by Piatkus. Some of her books have also been translated into other languages, including Portuguese, Bulgarian, Romanian, Estonian and Hebrew.

In recent years Penny has become even more drawn to follow the traditional Japanese origins of Reiki, so her Seminar on “The Spirit of Reiki” at the camexpo at Earls Court introduces some of the original teachings of Mikao Usui, the founder of the Reiki healing system. She will describe the differences in the three levels of training between the West and in Japan, and will also explain how to carry out the daily spiritual practice required of all Usui’s Japanese Reiki students. This will include the importance of the Reiki Principles/ Precepts, and there will be the opportunity to learn them in Japanese, as well as the chance to practise “Hatsurei-ho”, an important traditional meditation and energy cleansing technique.

Penny now lives and works in the Cotswolds, writing about and teaching Reiki, as well as leading occasional retreats and other workshops on personal and spiritual development.

For information about her books, courses and workshops, please go to her website, www.reiki-quest.co.uk.

To attend Penelope Quest’s seminar “The Spirit of Reiki” at camexpo this Saturday go to www.camexpo.co.uk and register for your ticket.

Dr Jayne Donegan was formerly a strong supporter of the UK’s Universal Childhood Vaccination Programme. Research led her to change her opinion.

“Vaccination – The Question” is a seminar which Dr Jayne Donegan will be holding at CNM (College of Naturopathic Medicine) in central London on Monday 11th November from 6.30pm to 8.30pm. She will review the impact, efficacy and safety of vaccinations, and look at what options are on offer to families who do not choose vaccination. Tickets cost £10 each and can booked on line at www.naturopathy-uk.com or call 01342 410 505.

In her article below, Dr Donegan explains what led her to change her opinion about vaccination, and about ‘The Doctor’s Dilemma’ when findings do not accord with mainstream medical teaching.

The Doctor’s Dilemma – Dr Jayne Donegan

By Dr JAYNE LM DONEGAN MBBS DRCOG DCH DFFP MRCGP MFHom

GP & Homeopath

Having trained as a conventional medical doctor, qualifying from St Mary’s Hospital Medical School, University of London, in 1983, all of my undergraduate teaching and post graduate experience in Obstetrics & Gynaecology, Family Planning, Child Health, Orthopaedics, Emergency Medicine and General Practice led me to being a strong supporter of the Universal Childhood Vaccination Programme. Indeed, I used to counsel parents in the 1980s who didn’t want to vaccinate their children against whooping cough – which was regarded as the ‘problematic’ vaccine in those days. I used to tell them that there were, indeed, adverse reactions, associated with the vaccine – I was not one of those doctors who would gloss over such unpleasant details – but that we doctors were told that the adverse reactions that might occur after the pertussis vaccine were at least ten times less likely the chance of getting complications from having the disease, and that, essentially, the point of giving their child the vaccine was to prevent them from getting the disease. Indeed, I used to think that parents who didn’t want to vaccinate their children were either ignorant, or sociopathic. I believe that view is not uncommon amongst doctors today.

Why did I have this attitude? Well, throughout my medical training I was taught that the people who used to die in their thousands or hundreds of thousands from diseases like diphtheria, whooping cough and measles – diseases for which there are vaccines – stopped dying because of the introduction of vaccines. At the same time I was taught that diseases like typhus, cholera, rheumatic and scarlet fever for which there are no vaccines, stopped killing people because of improvements in social conditions. It would have been a logical progression to have asked myself why, if social conditions improved the health of the population with respect to some diseases, would they not improve their health with regard to them all, but, the amount of information that you are required to absorb during medical training is so huge, that you just tend to take it as read and not make the connections that might be obvious to someone else.

When my children were born in 1991 and 1993 I unquestioningly – well that is to say I thought it was with full knowledge backed up by all my medical training – had them vaccinated, up as far as MMR, because that was the right thing to do. I even let my four-week-old daughter be injected with an out of date BGC vaccine at a public health clinic. I noticed (force of habit, I automatically scan vials for drug name, batch number and expiry date) that the vaccine was out of date and said, “Oh, excuse me, it looks like it’s out of date”, and the doctor answered matter-of-factly , “Oh don’t worry, that’s why the clinic was delayed for an hour, we were just checking that it was OK to give it, and it is”, and I said “OK,” and let her inject it…… my poor daughter had a terrible reaction, but I was so convinced that it was all for the best that I carried on with all the rest of them at two, three and four months.

That is where I was coming from – even my interest in homeopathy didn’t dent my enthusiasm for vaccines, so far as I could see, it was the same process – give a small dose of something and it makes you immune – no conflict.

So what happened?

In 1994 there was the Measles Rubella Campaign in which seven million school children were vaccinated against measles and rubella. The Chief Medical Officer sent out letters to all GPs, Pharmacists, Nursing Officers and other health care staff, telling us that there was going to be an epidemic of measles. The evidence for this epidemic was not published at the time. In later years it seems that it was predicted by a complicated mathematical model based on estimates and so might never have been going to occur at all. We were told, “Everybody who has had one dose of the vaccine will not necessarily be protected when the epidemic comes. So they need another one.” Well, that’s OK,” I thought, “because we know that none of the vaccines are 100% effective.”

What did worry me, however, was when they said that even those who had had two doses of measles vaccine would not necessarily be protected when the epidemic came and that they needed a third. You may not remember, but in those days there was only one measles vaccine in the schedule. It was a live virus vaccine, so it was like coming in contact with the wild virus, just changed slightly to make it safer and leading to immunity. Since then, of course, the pre-school dose has been added because one dose didn’t work, but in those days there was just ‘one shot for life’.

And now we were being told that even two shots of a ‘one shot’ vaccine would not protect people when the epidemic came. At this point I I began to ask myself, “Why have I been telling all these parents that vaccines are safer than getting the disease and that basically, having the vaccine will stop their children getting the disease – with the risk of complications – it’s not 100%, but that’s basically what they designed to do – when it seems that they can be vaccinated, have whatever adverse reactions are associated with the vaccine and get the disease with whatever complications may be associated with that, even when they’ve had two doses of the ‘one shot’ vaccine? This doesn’t seem right.”

If you are wondering how come anyone would have had two doses of the ‘one shot vaccine’, it is because when the MMR was introduced in 1988, many children had already been vaccinated against measles, but we were told that we should give them the MMR anyway as it would, “protect them against mumps and rubella and boost their measles immunity.”

We were also told that the best way of vaccinating was en masse, because this would ‘break the chain of transmission’. So I thought, “I wonder why we vaccinate all these small babies at two, three and four months, why don’t we just wait two or three years and then vaccinate everyone who has been born in the meantime, and ‘break the chain of transmission.’”

So some things just didn’t seem to quite add up. However it is very hard to start seriously questioning whether or not vaccination is anything other that safe and effective, especially when it is something that you have been taught to believe in so strongly. The more medically qualified you are, the more difficult it is, as, in some ways the more brainwashed you are. It’s not easy, or at least it wasn’t then, to start going down a path that might lead you in the opposite direction to all your colleagues and the healthcare system in which you work.

I read some books that could be described as ‘anti-vaccination’. These contained graphs showing that the majority of the decrease in deaths from and incidence of the infectious diseases for which we have vaccines occurred before the vaccines were introduced in the 1950s and 60s for example with whooping cough and the late 1960s with measles. I decided that I couldn’t just accept what these books were telling me, especially as the message was the opposite to what I had learned up until now. I needed to do some research. The graphs in my text books and the Department of Health Immunisation Handbook (the Green Book) appeared to show that the introduction of vaccines caused precipitous falls in deaths from vaccinatable diseases.

I decided that if I were going to sincerely challenge what I’d been taught at medical school and by my professors, I would have go and get the real data for myself.

Accordingly, I called the Office for National Statistics (ONS) and asked them to send me the graphs of deaths from the diseases against which we vaccinate from the middle of the nineteenth century, when we started keeping records ,until now. They said, “We don’t have them – except for smallpox and Tb, we suggest you try the Department of Health.” Which I did. They didn’t have graphs from the nineteenth or early twentieth century either. They said, “You’d better try the Office for National Statistics.” “I’ve already tried them,” I said, “They were the ones who advised me to contact you.” It seemed to be getting rather circular, so I called up the ONS once again and told them my problem. “Well,” they said, “We have all the books here from when the Registrar General started taking returns of deaths from infectious diseases in 1837, you can come along and look at them if you like.”

There was nothing for it. I had to go the Office for National Statistics (ONS) in Pimlico, with my two young children aged six and four in tow, to extract the information myself. The girls were very good – they were used to travelling/ following me around – and the library staff were very nice; they kindly gave my daughters orange juice to drink, and paper and crayons to draw with and amuse themselves, while I while I pulled out all the mothy old books from 1837 until 1900, after which, thankfully, there was a CD ROM that could be bought at vast expense and taken home. It was the most user unfriendly piece of data storage that I have ever come across but it was better than having to physically be there day after day. So I went home all my notes home and the CD Rom and eventually produced my own graphs. I was startled to find that they were similar to the graphs in some of the books that I had recently read.

I was astonished and not a little perturbed to find that when you draw a graph of the death rate from whooping cough that starts in the mid nineteenth century you can clearly see that at least 99% of the people who used to die of whooping cough in the nineteenth and early twentieth century has stopped dying before the vaccine against whooping cough was introduced, initially in the 1950s and universally in the 1960s. I also realised that the reason the Department of Health’s graphs made the vaccine appear so effective was because they didn’t start until the 1940s when most of the improvements in health had already occurred, and this was before even antibiotics were generally available. If you selected only deaths in under 15 year-olds, the drop is even more dramatic – by the time whooping cough vaccine was part of the universal immunisation schedule in the early 1960s all the hard work had been done.

I now began to realise that graphs such as those featured in the in the Department of Health,Green Book were not a good or clear way of showing the changes in mortality (death) and morbidity (incidence of disease) that occurred before and after vaccination was introduced against these diseases.

Measles is the similar: the Department of Health Green Book features a graph that does not start until the 1940s. There appears to be great drop in the number of cases after the measle vaccine was introduced in 1968, but looking at a graph which goes back to the 1900s you can see that the death rate – death being the worst case complication of a disease – had dropped by 99% by the time the vaccine was put on the schedule. Looking specifically at under 15-year-olds, it is possible to see that there was a virtual one hundred percent decline in deaths from measles between 1905 and 1965 – three years before the measles vaccine was introduced in the UK.

In the late 1990s there was an advertisement for MMR which featured a baby in nappies sitting on the edge of a cliff with a lion prowling on the other side and a voice over saying, “No loving parent would deliberately leave their baby unprotected and in danger.” I think it would have been more scientific to have put one of the graphs using information from the ONS in the advert – then parents would have a greater chance of making an informed choice, rather than being coerced by fear.

When you visit your GP or Heath Visitor to discuss the vaccination issue, and you come away feeling scared, this is because you are picking up how they feel. If all you have is the ‘medical model’ for disease and health, all you know is that there is a hostile world out there and if you don’t have vaccines, antibiotics and 100% bactericidal hand wash, you will have no defence at all against all those germs with which you and your children are surrounded. Your child may be OK when they get the measles but you can never tell when disaster will strike, and they may be left disabled or dead by the random hand of fate. I was like that myself, and when the awful realisation began to dawn on me that vaccines weren’t all they were cracked up to be, I started looking in a panic for some other way of protecting my children and myself – some other magic bullet.

My long, slow journey researching the vaccination disease ecology involved learning about other models and philosophies of health and the gradual realisation that it was true what people had told me all along, that ‘health is the only immunity.’ We don’t need protecting from out there. We get infectious diseases when our body needs to have a periodic clean out. Children especially benefit from childhood spotty rashes, or ‘exanthems’ as they are called, in order to make appropriate developmental leaps. When we have fevers, coughs, rashes, we need to treat them supportively, not suppressively. In my experience, the worst complications of childhood infections are caused by standard medical treatment which involves suppressing all the symptoms.

What is the biggest obstacle to doctors’ even entertaining the possibility that the Universal Childhood Vaccination Program may not the unmitigated success that it is portrayed to be? Or that there may be other ways of achieving health that are better and longer lasting? Possibly it is the fear of stepping out of line and being seen to be different – with all the consequences that this can entail, as I know from personal experience . As George Bernard Shaw says in his preface to ‘The Doctor’s Dilemma’ 1906 :

“Doctors are just like other Englishmen: most of them have no honour and no conscience: what they commonly mistake for these is sentimentality and an intense dread of doing anything that everybody else does not do,

GP & Homeopath, Dr Jayne Donegan trained as a conventional medical doctor, qualifying from St Mary’s Hospital Medical School, University of London, in 1983. She has experience in Obstetrics & Gynaecology, Family Planning, Child Health, Orthopaedics, Emergency Medicine and General Practice. She is also a Homeopath, specialising in childhood issues, and is the author of numerous papers such as ‘Vaccinatable Diseases and their Vaccines’. www.jayne-donegan.co.uk

Don’t miss “Vaccination – The Question”, a seminar by Dr Jayne Donegan at CNM (College of Naturopathic Medicine) in central London on Monday 11th November from 6.30pm to 8.30pm. Book here or call 01342 410 505.